Management & Treatments to Improve Sexual Desire & Performance
Both men and women can have episodes in their life when they feel they wish to improve their sexuality; either with increased desire or performance. Many diseases and medications can alter these, as can just the process of aging, psychological stress, mental health issues and illegal drugs.
At Your Private Doctor, our doctors have developed specific expertise in the management of these conditions. We use a combination of medicines, lifestyle changes and psychotherapeutic approaches which include stress management techniques, counselling, psychosexual programmes, cognitive behavioural therapy, as well as new-age type interventions such as visualizations. As these situations may often be due to a relationship, and not only related to the individual patient, we can offer interventions involving both members of a partnership, be whatever that is. Our techniques are not only limited to heterosexual relationships. We respect all unions no matter what the mixture of gender, or sexual orientation, or sexual practices involved. These improvements are grouped under three headings: i. Libido, desire and sexual excitement
Decrease in libido, sexual desire, and excitation Erectile dysfunction, vaginismus and sexual performance
Unsatisfactory sexual performance, which in the male usually involves a degree of erectile dysfunction (ED) or impotence, where there is failure to get or sustain an erection sufficient for satisfactory penetration for sufficient duration to satisfy both parties, and in the woman vaginal spasm, pain on intercourse or a decrease or absence of lubrication i i. Orgasm and ejaculation
Difficulties with orgasm, either with a prolonged time to orgasm, loss of erection or excitement of either party before orgasm, or of a complete failure of orgasm, known as anorgasmia.
All three may be caused by either physical or mental issues, the physical issues may be due to problems such as concurrent medication for pain or medicines for mental health disorders such as selective serotonin reuptake inhibitors (SSRIs) like Prozac, Paroxetine and Citalopram. The physical conditions and medical issues are numerous and varied. There may be difficulties with sensation, the nerves going to or from the genital area may not be working properly, there may be hormonal problems such as decreased testosterone in the man, hormonal problems in the woman or an increase in prolactin in both. Other medical issues in men may be problems with the prostate, and in men and women urinary tract infections and cardiovascular and heart disorders. There may be problems with organs such as the liver, the thyroid, the kidneys or general illnesses resulting in inflammation or infection anywhere in the body or high cholesterol and diabetes. The mental health problems may be stress at work, with children, or within the relationship. Sexual health issues are common in depression and anxiety and in other areas of poor mental health.
Lifestyle issues may involve obesity, alcohol or smoking, all of which decrease sexual performance. All our patients receive, if necessary, a full medical and mental history examination and appropriate blood tests for testosterone, prolactin, full blood counts, liver function tests, tests for various types of anaemia, thyroid function tests and many others.
The treatments we offer may be medicines, psychotherapy, psychosexual counselling, or couples therapy. We have a pragmatic down to earth approach and may recommend changes in sexual practice to increase desire, erection and lubrication and orgasm. We have specific medicines for premature ejaculation to delay time to orgasm and introduce patients to various simple techniques that they can practise themselves. We may also suggest tantric based therapies. Premature ejaculation is almost always due to psychological issues and we can help these patients with simple self-help procedures which are easily taught. For erectile dysfunction we use all the drugs like Viagra and Cialis, indeed one of our doctors did a lot of the early work on the safety of Viagra, as well and developing and registering other compounds for erectile dysfunction and impotence. Our medicines not only involve those taken orally, but may be the local application of medicines such as prostaglandins using a cream directly onto and into the penis. As a last resort we may recommend penile injections.
We always check men for lowered testosterone activity and if we find this, will prescribe testosterone, watching carefully for the adverse effects. In specific circumstances in women we may also use low dose testosterone if there is no contra indication. There are many other medicines we may use.
We fully believe in an interactive approach and may use psychosexual therapeutic interventions for men, women and couples. It is surprising how often our suggestions of changes in the way couples communicate sexually leads to a great improvement in desire, erection, lubrication and orgasm.


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